Echocardiography-derived Pre-induction Hemodynamic Phenotypes and Post-induction Hypotension: an Exploratory Clustering Analysis

Post-induction hypotension (PIH) was recognized as a common and clinically significant complication associated with adverse perioperative outcomes. This study was conducted as a retrospective analysis of prospectively collected data from adult patients undergoing elective surgery under general anesthesia.

The objective was to evaluate whether pre-induction hemodynamic status, assessed using echocardiographic parameters and routine clinical variables, was associated with the occurrence and timing of PIH. The analysis focused on identifying distinct hemodynamic profiles reflecting underlying cardiovascular physiology.

Unsupervised clustering (k-means) was applied to pre-induction variables to identify phenotypes, and principal component analysis was used to explore variable contributions. Latent profile analysis was performed as a sensitivity analysis. The association between phenotypes and PIH was assessed using time-to-event analysis.

No additional interventions were performed, and patient management was not influenced by the study. All analyses were conducted on anonymized data.

This study aimed to improve the understanding of variability in hemodynamic responses to anesthesia induction and to support future strategies for individualized perioperative care.

Inclusion criteria

Patients scheduled for elective abdominal surgery under genral anesthesia.

Exclusion criteria

• patients with dyspnoea
• unstable angina,
• severe valvular heart disease
• anticipated or unanticipated difficult airway management
• suspected increased intra-abdominal pressure
• poor echogenicity.